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Urgent Need to Improve Early Detection of MCI in Primary Care


Detection rates of mild cognitive impairment (MCI) in primary care are extremely low, with only about 8% of expected cases diagnosed on average, a finding that points to an urgent need to improve early detection in primary care.


  • Researchers estimated MCI detection rates among 226,756 primary care clinicians and 54,597 practices that had at least 25 patients enrolled in Medicare between 2017-2019. 

  • They compared the expected number of MCI cases, based on a predictive model, to actual diagnosed cases as documented in claims and encounter data.

  • They accounted for uncertainty in these estimates to determine whether detection rates are within the expected range or significantly higher or lower.


  • More than 25% of clinicians and practices did not have a single patient with diagnosed MCI; the average detection rate was 0.01 for both clinicians and practices.

  • The modeled expected MCI detection rate, however, was much higher (average 0.19 for clinicians and 0.20 for practices).

  • Average detection rates for clinicians and practices was 0.08, with more than 99% of clinicians and practices underdiagnosing MCI; clinicians practicing geriatric medicine had higher detection rates than others.


The findings are “concerning not only because patients might not get identified for a disease-modifying AD treatment in time, but also because numerous causes of MCI — such as hypothyroidism and medication side effects — are reversible, and the condition itself can be stabilized by lifestyle modification interventions,” the authors write.


The study, with first author Ying Liu, PhD, from University of Southern California, Los Angeles, was published online October 24 in the Journal of Prevention of Alzheimer’s Disease.


The predictive model based on demographic information has only moderate accuracy. Expected prevalence of MCI was based on cognitive test scores, which is not the same as a true clinical diagnosis.


The study was partially funded by a contract from Genentech to the University of Southern California. Co-authors Soeren Mattke and Christopher Wallick have disclosed relationships with Genentech.

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